Ethical challenges in contemporary psychiatry: an overview and an appraisal of possible strategies and research needs

作者：Silvana Galderisi, Paul S. Appelbaum, Neeraj Gill, Piers Gooding, Helen Herrman, Antonio Melillo, Keris Jän Myrick, Soumitra Pathare, M. K. Savage, George Szmukler, John Torous · 发表于：World Psychiatry · 年份：2024 · DOI：10.1002/wps.21230 · 被引用次数：63 · 研究领域：Mental Health and Psychiatry、Mental Health and Patient Involvement、Schizophrenia research and treatment

Psychiatry shares most ethical issues with other branches of medicine, but also faces special challenges. The Code of Ethics of the World Psychiatric Association offers guidance, but many mental health care professionals are unaware of it and the principles it supports. Furthermore, following codes of ethics is not always sufficient to address ethical dilemmas arising from possible clashes among their principles, and from continuing changes in knowledge, culture, attitudes, and socio-economic context. In this paper, we identify topics that pose difficult ethical challenges in contemporary psychiatry; that may have a significant impact on clinical practice, education and research activities; and that may require revision of the profession's codes of ethics. These include: the relationships between human rights and mental health care, research and training; human rights and mental health legislation; digital psychiatry; early intervention in psychiatry; end-of-life decisions by people with mental health conditions; conflicts of interests in clinical practice, training and research; and the role of people with lived experience and family/informal supporters in shaping the agenda of mental health care, policy, research and training. For each topic, we highlight the ethical concerns, suggest strategies to address them, call attention to the risks that these strategies entail, and highlight the gaps to be narrowed by further research. We conclude that, in order to effectively addre...